Method of spinal fixation using adhesive media

ABSTRACT

Disclosed are methods of spinal fixation involving application of a liquid medium which cures, hardens, polymerizes or otherwise serves to bind adjacent vertebrae together. The fixation which results from this binding may be temporary or essentially permanent in duration, and may be used to treat conditions or disease of the spine, such as inflammation, instability or fracture. In a preferred embodiment, the liquid medium comprises a low viscosity cyanoacrylate-based adhesive.

BACKGROUND OF THE INVENTION

[0001] 1. Field of the Invention

[0002] The present invention relates to a method of spinal fixationinvolving application of a liquid medium which cures, hardens,polymerizes or otherwise serves to bind adjacent vertebrae together. Thefixation which results from this binding may be temporary or essentiallypermanent in duration.

[0003] 2. Description of the Related Art

[0004] The spinal vertebrae are separated by cartilage disks, filledwith a gelatinous substance, that provide cushioning to the spinalcolumn. These disks may herniate or rupture from trauma or strain,especially if degenerative changes have occurred in the disk.

[0005] A herniated intervertebral disk, also known as a slipped orruptured disk, is a condition in which part or all of the soft,gelatinous nucleus pulposus in the central portion of an intervertebraldisk is forced through a weakened part of the annulus fibrosis,resulting in back pain and nerve root irritation.

[0006] Most herniation takes place in the lumbar area of the spine.Lumbar disk herniation occurs 15 times more often than cervical diskherniation, and it is one of the most common causes of lower back pain.The cervical disks are affected 8% of the time and the thoracic disksonly 1 to 2% of the time. When lumbar disk herniation occurs, nerveroots, the large nerves that branch out from the spinal cord, may becomecompressed resulting in neurological symptoms such as pain or weaknessin the back and lower extremities.

[0007] Although minor cases of disk herniation may be treated with bedrest and medications to relieve pain and reduce inflammation, surgerymay be indicated for people who fail to respond to bed rest andmedications.

[0008] One common type of surgery performed to alleviate back pain isdiscectomy. Discectomy involves the surgical removal of the diseaseddisc, thereby relieving the pressure. In spite of the fact that theprocedure has been done for many years, few studies have been conductedto determine its real effectiveness. Scar tissue may develop afterdiscectomy, which, in some cases, can cause continued pain.

[0009] Another common procedure is spinal fusion. Spinal fusion involvesmaking a percutaneous incision or puncture over the affected area of thespine and joining the vertebrae together using bone grafts and/or rodsmade of metal or other materials of substantial strength.

[0010] Another procedure performed is laminectomy. Laminectomy isperformed to remove the protruding disk. This procedure involvesremoving the bone that curves around and covers the spinal cord (lamina)and the tissue that is causing pressure on the nerve or spinal cord.

[0011] Complications of spinal surgery can include nerve and muscledamage, infection, scarring, and the need for re-operation. Patientsoften remain hospitalized for several days after surgery, and in bed foranywhere from a few days to a few weeks following surgery. A back braceor cast may be necessary for weeks following the surgery to immobilizethe spine until the fusion has occurred.

SUMMARY OF THE INVENTION

[0012] In accordance with one preferred embodiment, there is provided amethod of temporary spinal fixation. The method comprises identifying afirst and a second adjacent surfaces in a spine, the first and secondsurfaces in sliding contact with each other at a joint and introducing amedium between the first and second surfaces which undergoes a physicalor chemical change to immobilize the joint.

[0013] In accordance with another preferred embodiment, there isprovided a method of immobilizing a portion of the spine. The methodcomprises identifying a joint between a first vertebra and a secondvertebra which is to be immobilized, and administering an adhesivemedium to bond at least a first superior articular process on the firstvertebra to a corresponding first inferior articular process on thesecond vertebra, wherein the medium comprises cyanoacrylate.

[0014] In accordance with another preferred embodiment, there isprovided a method of treating inflammation in the spine. The methodcomprises identifying a joint between a first vertebra and a secondvertebra which is in the vicinity of an inflammation, and administeringan adhesive medium to bond at least a first superior articular processon the first vertebra to a corresponding first inferior articularprocess on the second vertebra to temporarily immobilize the joint for asufficient time to treat the inflammation, wherein the administeringstep is accomplished without a surgical cut down.

[0015] In accordance with still another preferred embodiment, there isprovided a method of immobilizing a portion of the spine. The methodcomprises identifying a joint between a first vertebra and a secondvertebra which is to be immobilized, and administering a thin film of amedium comprising an adhesive within the joint to bond at least a firstsuperior articular process on the first vertebra to a correspondingfirst inferior articular process on the second vertebra.

BRIEF DESCRIPTION OF THE DRAWINGS

[0016]FIG. 1 is a left lateral view of the lumbar region of the humanspine.

[0017]FIG. 2 is a posterior view of the third and fourth lumbar vertebraof the human spine.

[0018]FIG. 3 is a superior view of an intervertebral disk.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

[0019] The present invention relates to a method of spinal fixationinvolving application of a liquid medium which cures, hardens,polymerizes or otherwise serves to bind adjacent vertebrae together. Thefixation which results from this binding may be temporary or essentiallypermanent in duration, and may be used to treat inflammation, diskherniation, and/or fracture or instability in the spine.

[0020] The terms “medium” and “media” as used herein, refer to theliquid material used according to preferred embodiments herein to joinone or more adjacent vertebrae. Preferred media comprise an adhesive,which is used in a broad sense to include single component or multiplecomponent materials, curable compositions, polymerizable compositions,cements, as well as other types of materials or compounds, presentlyknown or later-developed, which may be used to join, bond or adheresurfaces or materials together. Suitable adhesives include bothbiological and non-biological adhesives. The class of materials referredto herein as adhesives includes curable compositions, including, but notlimited to those which cure by mixing two or more component parts, thosewhich cure by cross-linking, and those which cure in the presence ofsome activator, accelerant or catalyst, including, but not limited towater, heat, chemicals, or radiation. Adhesives also includepolymerizable compositions, which preferably comprise one or moremonomers or oligomers which polymerize or further polymerize followingapplication to the desired site. A medium may consist solely of oressentially of one or more adhesives, or it may further comprise one ormore additional materials. Additional materials include those whichmodify properties of the adhesive, as well as those which impart otherdesirable properties or characteristics to the medium.

[0021] Examples of preferred adhesives include cyanoacrylates, epoxies,fibrin-based adhesives, as well as other presently known orlater-developed materials suitable for use in the methods disclosedherein. Polymerizable adhesives that have been cross-linked orco-polymerized with other compounds that may alter elasticity, modifyviscosity, aid biodegradation or change some other property of theresulting material may be used in media. For example, polyacrylic acidmay be cross-linked to a cyanoacrylate to form compounds which may allowfor greater bioabsorbability.

[0022] Cyanoacrylates are among the preferred adhesives used in media asdisclosed herein. Among the reasons why cyanoacrylates are preferred arethat they can harden almost instantaneously on contact with surfaceshaving moisture thereon, including most tissues and surfaces in the bodyof an animal, such as a human. Preferred cyanoacrylates include, but arenot limited to, methyl cyanoacrylate, ethyl cyanoacrylate, n-propylcyanoacrylate, isopropyl cyanoacrylate, n-butyl cyanoacrylate, isobutylcyanoacrylate, n-amyl cyanoacrylate, isoamyl cyanoacrylate,3-acetoxypropyl cyanoacrylate, 2-methoxypropyl cyanoacrylate,3-chloropropyl cyanoacrylate, benzyl cyanoacrylate, phenylcyanoacrylate, alkenyl cyanoacrylate, butyl-2-cyanoacrylate, alkoxyalkyl2-cyanoacrylates, fluorinated 2-cyanoacrylates, and carbalkoxyalkylcyanoacrylates, depending upon acceptable toxicity and other propertiesfor a given application. More preferably the adhesive compound comprisesethyl cyanoacrylate or butyl-2-cyanoacrylate. These latter twocompounds, are available commercially from Loctite Corporation(Hartford, Conn.) or Pacer Technology (Rancho Cucamonga, Calif.). Othermembers of the cyanoacrylate family may be commercially available or maybe synthesized according to published procedures or analogous methods asis within the abilities of one skilled in the art. Also suitable arecommercially available cyanoacrylate based tissue adhesives such asDermabond® (Johnson & Johnson, New Brunswick, N.J.).

[0023] Preferred fibrin-based adhesives include those which includecomponents having human, animal or recombinant origin. Such adhesivesinclude, but are not limited to, adhesives comprising thrombin andfibrinogen delivered separately or mixed at the site to be bonded,adhesives comprising fibrinogen and Factor XIII, adhesives produced nearthe time of use from autologous components, and adhesives as describedin U.S. Pat. Nos. 6,019,993, 6,063,297, 5,716,645, 5,962,405, 5,605,887,5,883,078, and 5,464,471, the disclosures of which are incorporatedherein by reference in their entireties. Also suitable are commerciallyavailable fibrin based adhesives, including Tissucol® (Immuno A.G.,Vienna, AT) and Tisseel® (Baxter Healthcare Corp., Deerfield, Ill.).

[0024] Media employed in preferred embodiments may comprise componentsand materials in addition to adhesive. Such other components include,but are not limited to, inhibitors, activators, catalysts, colorants,dyes, including colored dyes, radioscopic dyes and fluoroscopic dyes,radiopaque components, drugs, viscosity modifiers, and wetting agents.In one preferred embodiment, a medium comprises a cyanoacrylate and alow viscosity inhibitor. One preferred low viscosity inhibitor is sulfurdioxide. Such embodiments preferably have a very low, water-likeviscosity such that capillary action or the natural wetting action cancause the medium to be pulled in to a thin opening, including the spacebetween the articular processes which are coated with smooth, slipperycartilage or other such slidable areas to be fused.

[0025] In discussing the viscosity of the media in the context of thepreferred embodiments, the viscosity referred to generally is theviscosity of the medium at the time it is being applied. Followingapplication, the medium will increase in viscosity until it “sets up” toa final solid or relatively solid state due to the action of one or morephysical or chemical mechanisms in the medium, including, but notlimited to curing, cross-linking, polymerizing, hardening, andevaporation of solvent. Once the medium has set up, it preferably takesa solid form, which may be somewhat flexible or may be relatively stiff.In one embodiment, the pre-application or application time viscosity ofa medium is preferably about 10-50,000 centipoise (cp), more preferablyabout 10-5,000 cp or 10-100 cp, including about 20 cp, about 30 cp,about 50 cp, and about 75 cp. Media having viscosities outside of thesestated ranges and values may also be suitable, depending upon one ormore of several factors, including, but not limited to the location andmethod of application. In a preferred embodiment, the medium has aviscosity sufficiently low to permit it to be pulled into a small gapbetween surfaces under capillary action.

[0026] It is preferred that media used in the methods described hereinexhibit a good ability to coat or wet the surfaces of the spine to whichthey are applied so as to aid application and creation of a firm andeven bond.

[0027] Another characteristic of a medium is the time required for themedium to set up to the point where a reasonable degree of fixation orimmobilization of the target region of the spine is achieved. Areasonable degree of fixation is generally thought to be achieved whenat least moderate movement of the back area of the patient does notdisrupt the bond. Once it has set up, a medium may still undergo furtherpolymerization, reaction, curing, hardening or other chemical orphysical phenomenon to achieve a final state or bond. It is preferredthat the set up time is fairly short, so as to shorten the overall timeof the procedure. A short set up time also allows the physician (orother such practitioner) to confirm that the fusion or immobilizationhas occurred properly. It is also preferred, however, that the set uptime not be too short as to interfere with the physician's need toadjust or position the vertebrae and/or other surfaces being joinedduring the procedure. In one embodiment, the set up time is preferablyless than about 20 minutes, less than about 10 minutes, or less thanabout 5 minutes, including about 10 seconds to about 10 minutes, andabout 30 seconds to about 2 minutes. Media having set up times outsideof these stated ranges and values may also be suitable, depending uponone or more of several factors, including, but not limited to the methodof application and the time needed to properly position the spine.

[0028] The set up time can be altered by choice of adhesive in themedium. Additionally, for a given adhesive, the set up time can beincreased or decreased by the use of (or by varying the amounts of)catalysts, activators, inhibitors, monomers, and other such componentsin the medium.

[0029] Depending upon the length of time it is desired for the vertebraeto be fixed together, the degree of biodegradability or bioabsorbabilityin the medium employed may be varied. For example, if temporary fixationis desired, such as for a period of weeks or months, a higher degree ofbiodegradability or bioabsorbability in the medium is desired. Temporaryfixation can be for a period of about 1 to 12 months, or 1 to 5 weeks,although longer and shorter periods of time are also contemplated. If,however, more permanent fixation is desired, such as for a period ofseveral years, it is preferable to use a medium that is only slowlydegradable or substantially nonbiodegradable. Permanent orsemi-permanent fixation can be for a period of about 1 to 10 years,although longer or shorter periods of time are also contemplated. Modesof degradation or dissipation of the medium in the body over timefollowing fixation include, but are not limited to, those which occurdue to the presence of heat, water or aqueous fluids, enzymes or otheractive compounds, physical stress and/or shear forces. Degradation ordissipation may also result from a combination of modes.

[0030] There is a wide variation in the rates and facility of in vivobiodegradation of polymers made from monomers which may be used in mediaaccording to preferred embodiments. Generally, cyanoacrylates and otheradhesives that have substituents that are small and/or contain one ormore oxygen-containing functional groups (e.g. ether, ester, carbonyl)appear to have increased biodegradability rates. Conversely,cyanoacrylates and other adhesives having long chain alkyl groupslacking in oxygen-containing or polar functional groups as substituentsmay tend to form polymers that biodegrade more slowly. There are alsoindications that the biodegradation rate of polymer-based adhesives isaffected by the polymer molecular weight and crystallinity of thepolymer, with higher molecular weight and higher crystallinity generallyindicating a more stable, less degradable material.

[0031] To effectively immobilize or reduce the mobility of the targetedregion of the spine, a medium is applied to abutting or adjacentsurfaces in at least two adjacent vertebrae. Such surfaces preferablymove with respect to each other by sliding, rocking, or other suchmovement which occurs in a normally functioning spine. In accordancewith one embodiment, at least one medium is applied to one or moreadjacent surfaces, followed by bringing the surfaces together. In apreferred embodiment, at least one medium is applied to form a film orlayer or to fill a space between the surfaces. Following application,the film or layer preferably covers the entirety of the surfaces so asto have a larger, but preferably still thin, bonding surface and achievea stronger bond. Similarly, if the application of medium entails fillinga space, it is preferred that substantially the entire space be filledso as to maximize bonding force. Following the application of media andany time needed for set up, curing, or other physical and/or chemicalchanges, the surfaces and/or the vertebrae to which they are attachedshould be substantially prevented from moving relative to each other.

[0032] In a preferred embodiment, the introduction or application ofmedium to a site is effected using a tubular introducer, including, butnot limited to a cannula, needle or other hollow structure. The term“tubular” is intended to convey that preferred introducers are elongate,hollow structures which allow for the passage of media through thehollow space, rather than to convey any particular shape or profile.Accordingly, an introducer may have any suitable cross-sectional shapeincluding circular, ovoid, ellipsoid, polygonal, etc. In one embodiment,a first end of the introducer is attached to a reservoir or containerwhich provides for storage of medium before and/or during application. Asecond end of the introducer is preferably shaped into or fitted with arelatively fine tip to aid in precise application of media. In anespecially preferred embodiment, the second end of the introducer is aneedle-type point which also can readily puncture the skin to aid inpercutaneous application of the medium.

[0033] Media is expressed through the introducer using any suitablemeans, including, for example, pressure, gravity, and capillary action.One end of the introducer is placed at the desired location and themedium is then applied or expressed in the desired quantity. The mediummay be expressed directly into a target joint or capsule or onto one ormore surfaces. For example, the tip of the introducer may be placed nearthe center of a joint and the medium expressed. Alternatively, the tipof the introducer may be placed within a capsule or other space and themedium expressed to substantially fill, or at least partially fill, thespace. The medium may also be expressed near the edge of a joint, spaceor surface and then be forced by the flow of material into the joint,space or surface. If a low viscosity medium is used, the medium may beexpressed near the edge of a joint, space, or surface or it may beplaced in contact with same, allowing the medium to be drawn into thejoint, space or surface by means of capillary action.

[0034] In a preferred embodiment, two or more vertebrae are fusedtogether. Referring to FIG. 1 the lumbar region of the spine, containingfive vertebrae (L1-L5), is illustrated in a left lateral view. Aposterior view of the third and fourth lumbar vertebrae (L3-L4) isillustrated in FIG. 2. Both FIGS. 1 and 2 are dissections which showprimarily only the bony portions and the intervertebral disks. Althoughthe lumbar spine is shown, the techniques and methods disclosed hereinmay be used in or adapted to other locations in the spine. Furthermore,these techniques may be used and adapted for use in repair of bonesand/or cartilage in other parts of the body.

[0035] Each vertebra comprises a generally cylindrical vertebral body 10which is separated from its adjacent vertebrae by intervertebral disks12. Each vertebra further comprises several processes, among them thesuperior and inferior articular processes. The two superior articularprocesses 14 of each vertebra project upward and the two inferiorarticular processes 16 of each vertebra project downward. The superiorarticular processes 14 are wider apart than the inferior articularprocesses 16, since, when placed together in the spinal column, theinferior articular processes 16 of one vertebra are embraced by thesuperior processes 14 of the subjacent vertebra. Each superior process14 terminates in a facet 18 which is concave and looks backward andmedialward. Each inferior process 16 terminates in a facet 20 which isconvex and directed forward and lateralward. The facets 18 of thesuperior processes 14 of one vertebra thus mate with the facets 20 ofthe inferior processes 16 of the vertebra directly above to form azygapophyseal joint 22 where each pair of corresponding articularprocesses meet. Although not shown in the figures, there is a ligamentwhich extends from the inferior process of one vertebra to the superiorprocess of the vertebra immediately below, encapsulating thezygapophyseal joint 22 in what is known as the capsule of thezygapophyseal joint.

[0036] In accordance with one preferred embodiment, a medium is appliedto one or both zygapophyseal joints between a pair of vertebrae. Theapplication may occur within the joint, or the medium may be appliedprimarily to a facet of a superior process of one vertebra and/or to thecorresponding facet of the inferior process of the superjacent vertebra.It is preferred that enough media be applied to at least form a film orlayer over the entire surface area of a joint or facet, although smalleror larger amounts of medium may be used.

[0037] In an alternate embodiment, the medium is placed into the capsuleof the zygapophyseal joint to substantially fill, or at least partiallyfill the capsule with medium. In this manner, the capsule may be usedboth as a means of containing the medium and also as a way of extendingthe surface area over which the fusing bond acts.

[0038] As noted above, the fixation or bonding involving the articularprocesses between two vertebrae may be either unilateral (one pair ofarticular processes) or bilateral (both pairs of articular processes).Furthermore, this process can be repeated to provide for the fixation ofmore than one pair of vertebrae in a single spine. The multiple fixationpoints may be in adjacent groups of vertebrae, or they may benon-contiguous. In preferred embodiments, the vertebrae which are fixedtogether are in the lumbar region of the spine, and may also includefixation to the first vertebra of the adjacent sacral region. In oneembodiment, all five vertebrae which constitute the lumbar region arefixed together.

[0039] The fixation methods described above which involve the articularprocesses may be performed alone, or it may be combined with othertechniques of fusing or fixing the spine. For example, a medium may beused to fix the articulate processes in combination with use of rods orwires to fix the vertebral bodies. Alternatively, use of a medium to fixthe articulate processes may be combined with methods which involvestimulating the growth of a bony mass or fusion body to fix the spine.The fixation provided by the medium can provide extra support andstability to the spine so as to increase the chances of havingsuccessful fusion provided by the growth of bone.

[0040] Fixation of the spine need not be confined to the articularprocesses. Other adjacent portions of adjoining vertebrae may be fixedusing a medium. For example, a medium could be applied to fix adjacentvertebral bodies. One such method could involve applying a medium to theadjacent vertebral bodies and/or the intervertebral disk (or artificialdisk replacement) which separates them. Alternatively, a medium could beapplied to adjacent vertebral bodies to stabilize them followingdiscectomy.

[0041] Although many statements herein refer to preferred embodiments inwhich one medium is applied, it is presently contemplated that more thanone medium may be applied, either in concert or in series.

[0042] The temporary or more permanent fixation that results fromapplication of preferred methods disclosed herein may be used to treatconditions including, but not limited to, inflammation, disk herniation,instability, and fracture. The immobilization which results fromfixation can provide an environment in which spinal inflammation isreduced and in which a disk may heal itself, either entirely or enoughto reduce or eliminate the symptoms of disk herniation. The fixation canprovide stabilization of a region in the spine to allow forstrengthening of the muscles and other tissues in the spine throughphysical therapy, growth of a stable fusion body, and the like toprovide longer term repair and relief. Even if a procedure must berepeated periodically, preferred procedures, especially percutaneousprocedures, are less invasive and less traumatic than conventionalsurgical procedures. Similarly, procedures described herein may also beused as a “bridge” to a more extensive surgical procedure, providing foran alleviation of symptoms, lessening of pain, provision of stability tothe spine and/or other such aid to the patient on a temporary basisuntil such surgical procedure can be performed.

[0043] In some embodiments, application of a medium to one or morelocations is done in a surgical procedure. The surgical procedure mayinvolve only the fixation by means of medium, or it may be done incombination with other procedures, including, but not limited todiscectomy, fusion, and laminectomy. Such other surgical techniquesinvolving the spine may be enhanced or improved by incorporation oftechniques involving fixation using a medium as described herein.

[0044] Alternatively, fixation using a medium may be performedpercutaneously, without surgical cut-down, whether performed alone or incombination with some other technique or procedure, including, but notlimited to, discectomy and application of a medicament. In one preferredembodiment, fixation is performed percutaneously with the spine andintroducer being monitored and guided using fluoroscopy. Use offluoroscopy to visualize the spine and deliver drugs or perform a spinalpuncture is known and widely used. These same techniques can be adaptedto visualize and guide the introducer to the desired location, be it ajoint, capsule, surface or otherwise, to apply a medium. In a procedureusing fluoroscopy, it is preferred that the medium contains afluoroscopic dye or other agent to enable the medium to be visualizedduring the procedure, which allows the physician to monitor both theamount of medium delivered and the location of delivery. Techniquesother than fluoroscopy which allow visualization of the spine andintroducer including, but not limited to, ultrasound, may also be usedin connection with preferred percutaneous procedures.

[0045] Both surgical and percutaneous methods may further include a stepof aligning the spine prior to introducing the medium to help ensurethat the vertebrae will have proper positioning and alignment whenfixed. Preferred methods may include the additional step of providing ananesthetic, such as an epidural anesthetic, prior to initiating theintroduction of medium or other aspects of a procedure.

[0046] One preferred embodiment involves a method of temporary spinalfixation. The method comprises identifying first and second adjacentsurfaces in the spine that are in contact with each other at a joint,and introducing a medium between the first and second surfaces (whichmay include one or both such surfaces) or into the joint. The mediumpreferably then undergoes a physical or chemical change to fix orimmobilize the joint. For such temporary fixation, it is preferred thatmedia used are susceptible to biodegradation or bioabsorption.

[0047] In accordance with another preferred embodiment, there is amethod of immobilizing a portion of the spine. The method comprisesidentifying a joint between two vertebrae which is to be immobilized,and administering an medium to bond at least one surface on a firstvertebra and an adjacent surface on the second vertebra, preferably afirst superior articular process on one vertebra and the correspondinginferior articular process on the second vertebra.

[0048] In another preferred embodiment, there is provided a method oftreating inflammation in the spine. The method comprises identifying ajoint between a first vertebra and a second vertebra that is in thevicinity of an inflammation, and administering a medium to bond at leastone surface, preferably a first superior articular process, on the firstvertebra to an adjacent second surface, preferably the correspondingfirst inferior articular process, on the second vertebra to temporarilyimmobilize the joint for a sufficient time to treat the inflammation,wherein the administering step is preferably accomplished without asurgical cut down.

[0049] The procedures described herein may be coupled with epiduraladministration of one or more anti-inflammatory agents, including, butnot limited to, cortisone and other steroidal compounds. In preferredembodiments, the administration of the medium and/or theanti-inflammatory agent is performed using fluoroscopy to aid inplacement at the desired site.

[0050] Media may also be used to repair or augment the intervertebraldisks. As shown in FIG. 3, a disk 12 comprises two main regions: theannulus fibrosis 24 and the nucleus pulposus 26. The nucleus pulposus 26comprises a relatively soft gelatinous material that acts as a “shockabsorber” in the spine. It is surrounded and protected by the annulusfibrosis 24, a ring of relatively tough tissue. Herniation occurs whensome, or even substantially all, of the nucleus pulposus is forcedthrough a split, rupture, or weakened area of the annulus fibrosis.

[0051] Although, as noted above, it is believed that small ruptures in adisk can heal if the spine is rested or immobilized in the region of theinjured disk, larger ruptures in which there has been an expulsion oflarger amounts of pulpous material are not currently believed to becapable of self-repair. If the enucleated material is of a sufficientquantity to result in a change in the shape or size of the disk,instability of the spine may result. In such circumstances, it may bedesirable to add medium to the disk to augment any remaining nucleuspulposus. Preferably the medium used in such augmentation has elastic orresilient properties to mimic the natural contents of the nucleuspulposus. Adhesive properties of the medium can help the medium stay inplace inside the annulus fibrosis. Preferably the medium is expressedinto the interior of the disk using a tubular introducer. This proceduremay be performed percutaneously or surgically, and may be done incombination with removal of enucleated pulpous material and/or with anyof the aforementioned fixation techniques.

[0052] In addition to augmenting the nucleus, application of a mediummay be used repair the tear, hole, or other such disruption in theannulus fibrosis through which enucleation occurred. Such medium may beof a similar or different composition as the medium used to augment thenucleus pulposus. Alternatively, in those cases where sufficient naturalpulpous material remains in the disk, a medium may be used to repairtears, holes, and other disruptions in the annulus fibrosis with minimalor no augmentation of the nucleus. In such situations, the adhesiveproperties of the medium allow for repair or sealing of the damagedannulus when it is applied to one or more surfaces thereof.

[0053] The various methods and techniques described above provide anumber of ways to provide fixation or immobilization of at least aportion of the spine. Of course, it is to be understood that notnecessarily all objectives or advantages described may be achieved inaccordance with any particular embodiment described herein. Thus, forexample, those skilled in the art will recognize that the methods may beperformed in a manner that achieves or optimizes one advantage or groupof advantages as taught herein without necessarily achieving otherobjectives or advantages as may be taught or suggested herein.

[0054] Furthermore, the skilled artisan will recognize theinterchangeability of various features from different embodiments.Similarly, the various features and steps discussed above, as well asother known equivalents for each such feature or step, can be mixed andmatched by one of ordinary skill in this art to perform methods inaccordance with principles described herein.

[0055] Although the invention has been disclosed in the context ofcertain embodiments and examples, it will be understood by those skilledin the art that the invention extends beyond the specifically disclosedembodiments to other alternative embodiments and/or uses and obviousmodifications and equivalents thereof. Accordingly, the invention is notintended to be limited by the specific disclosures of preferredembodiments herein, but instead by reference to claims attached hereto.

What is claimed is:
 1. A method of temporary spinal fixation, comprisingthe steps of: Identifying a first and a second adjacent surfaces in aspine, the first and second surfaces in sliding contact with each otherat a joint; Introducing a medium between the first and second surfaceswhich undergoes a physical or chemical change to immobilize the joint.2. A method of temporary spinal fixation as in claim 1, wherein theintroducing step comprises percutaneously introducing the medium.
 3. Amethod of temporary spinal fixation as in claim 1, wherein theintroducing step is accomplished under fluoroscopic visualization.
 4. Amethod of temporary spinal fixation as in claim 1, wherein theintroducing step comprises introducing the medium through a tubularintroducer.
 5. A method of temporary spinal fixation as in claim 1,wherein the introducing step comprises introducing a medium whichcomprises cyanoacrylate.
 6. A method of temporary spinal fixation as inclaim 1, wherein the joint is in between adjacent vertebral bodies.
 7. Amethod of temporary spinal fixation as in claim 1, wherein the joint isin between an inferior articular process and a superior articularprocess.
 8. A method of temporary spinal fixation as in claim 1, furthercomprising the step of administering an epidural anesthetic prior to theintroducing step.
 9. A method of immobilizing a portion of the spine,comprising the steps of identifying a joint between a first vertebra anda second vertebra which is to be immobilized, and administering anadhesive medium to bond at least a first superior articular process onthe first vertebra to a corresponding first inferior articular processon the second vertebra, wherein the adhesive comprises cyanoacrylate.10. A method of immobilizing a portion of the spine as in claim 9further comprising the step of administering an adhesive medium to bonda second superior articular process on the first vertebra to acorresponding second inferior articular process on the second vertebra.11. A method of immobilizing a portion of the spine as in claim 9,wherein the adhesive further comprises a polymerization inhibitor.
 12. Amethod of immobilizing a portion of the spine as in claim 9, wherein theadhesive further comprises a radio opaque component.
 13. A method ofimmobilizing a portion of the spine as in claim 11, wherein the adhesivehas a viscosity of no more than about 100 centipoise.
 14. A method ofimmobilizing a portion of the spine as in claim 9, wherein theadministration step is accomplished percutaneously.
 15. A method oftreating inflammation in the spine, comprising the steps of identifyinga joint between a first vertebra and a second vertebra which is in thevicinity of an inflammation, and administering an adhesive medium tobond at least a first superior articular process on the first vertebrato a corresponding first inferior articular process on the secondvertebra to temporarily immobilize the joint for a sufficient time totreat the inflammation, wherein the administering step is accomplishedwithout a surgical cut down.
 16. A method of treating inflammation inthe spine as in claim 15, further comprising the step of administeringan adhesive medium to bond a second superior articular process on thefirst vertebra to a corresponding second inferior articular process onthe second vertebra.
 17. A method of treating inflammation in the spineas in claim 15, further comprising the step of permitting the adhesiveto dissipate following a treatment period of time.
 18. A method oftreating inflammation in the spine as in claim 17, wherein the treatmentperiod is within the range of from about one week to about six months.19. A method of treating inflammation in the spine as in claim 15,wherein the administering step is accomplished percutaneously.
 20. Amethod of treating inflammation in the spine as in claim 15 wherein theadhesive comprises cyanoacrylate.
 21. A method of treating inflammationin the spine as in claim 15, wherein the joint is in the lumbar regionof the spine.
 22. A method of treating inflammation in the spine as inclaim 15, wherein the joint is in the sacral region of the spine.
 23. Amethod of treating inflammation in the spine as in claim 15, wherein thejoint is in the L4-L5-S1 region of the spine.
 24. A method of treatinginflammation in the spine as in claim 15, wherein the administering stepcomprises expressing the adhesive near an edge of the joint, andpermitting the adhesive to enter the joint by capillary action.
 25. Amethod of treating inflammation in the spine as in claim 15, wherein theadministering step comprises positioning a distal end of an injectionneedle within the joint and expressing adhesive under pressure withinthe joint.
 26. A method of treating inflammation in the spine as inclaim 15, wherein the administering step is accomplished underfluoroscopy.
 27. A method of treating inflammation in the spine as inclaim 15, further comprising the step of augmenting a spinal nucleus atthe level of the joint.
 28. A method of treating inflammation in thespine as in claim 15, further comprising the step of aligning the spineprior to the administering step.
 29. A method of immobilizing a portionof the spine, comprising the steps of identifying a joint between afirst vertebra and a second vertebra which is to be immobilized, andadministering a thin film of adhesive medium within the joint to bond atleast a first superior articular process on the first vertebra to acorresponding first inferior articular process on the second vertebra.